Tag Archives: mental health

On 25th April, a group of 16 therapists of varying disciplines and experience attended a seminar presented by Professor Stephen Briggs (whose books include: Working with Adolescents and Young Adults: A contemporary psychodynamic approach (2008).

We had had the opportunity to download 26 of his slides which offered a framework for the discussions.

In the process of working with this age group, we understand that we have to do things differently from our work with child and adult populations, outlined as follows:

THERAPEUTIC STANCE:

Providing a combined containing and exploring space..(containing anxieties and exploring meaning). This combines taking in the feelings, making sense and feeding back whilst ‘holding’ urgency and anxiety. Also, enabling the young person to tolerate the ups and downs, extremes of excitement and depression; facilitating feelings of overwhelm and omnipotence, and taking these things seriously.

Being ‘adolescent-centred’..trying to understand the adolescent ‘world view’, without making assumptions about the adolescent’s knowledge or experience of the therapy process. This includes noticing how quickly adolescents can change and how stuck they can be in the developmental process. The therapist is required to take on the ‘in-between-ness’ of the client, moving responsively between more adult/more childlike states as they occur. Working with the ‘yes’ adolescent and the ‘no’ adolescent.

WORKING WITH DEPENDENCY:

Stephen Briggs explored the delicate issues around the adolescent’s potentially fragile sense of independence where the offer is to share with the therapist what is his, what can he share? What does the therapist need to know; what can be private and acknowledged as private?

The therapist needs to work out what the adolescent can and can’t bear, adapting to the fragile sense of separateness from parental figures, his aloneness in the world and the responsibility of his own thoughts and actions.

‘Becoming a subject’ – the process of gaining ownership..new adult, sexual body, ownership of one’s own thoughts. Ownership of drives, sensations, impulses, feeling and powers. With ownership of bodily changes comes both power and the power to enact. Power relationships evoke different capacity to enact thoughts and feelings.

Increased separateness from parental figures at the above levels.

From neuroscience, we’re told that with brain development, the slowest capacity to develop is the capacity to reflect.

For Separation and Individuation at one end of the axis and Regression on the other, there are transverse opposites:

Self -esteem and competence. Vs. Fear of failure
States of mind (subject to). Vs. Subject of
Power. Vs. Dependence
Life. Vs. Death

The retreat from death can lead to omnipotence and/or the need not to fit in with convention. Online/offline ambivalence engenders both omnipotence (with the provision of answers to problems) and the defeat of omnipotence (when the adolescent can’t solve the problem).

An example:
Exploring on line = securely attached
Looking for ‘belonging’ online = less securely attached.

These are part of the dichotomies to be held in mind through the therapeutic intervention in adolescent work.

We had a further three case studies to consider, discuss and apply the learning from the presentation as well as from our own experiences.

WORKING WITH TRANSFERENCE AND COUNTER-TRANSFERENCE:

In the transference:

drawing attention to connections between the social world and the therapeutic relationship.

making formulations about relatedness, maternal and paternal transference.

In the counter-transferential space:

what are we picking up as therapists of the adolescent feelings? What feelings are we evoking?

what about me is getting in the way of this work?

So what is both going on in the therapist and what from the adolescent is stirring up feelings in the therapist? Much of the rich discussion from the case studies surfaced transference and counter-transference explorations.

Appropriately we talked of endings, particularly from the last case study where breaks in the therapy and missed sessions brought important material for therapeutic thought.

Stephen said ‘there is always something about separation with adolescents…in the therapeutic relationship, we replay through separation from the therapist, those other issues of separation’. ‘We are introducing the adolescent to him or herself’.

Seminar: “Meditation as a Therapeutic Strategy” with Dr William Bloom, organised by Wendy Bramham Therapy

The research into the beneficial effects of meditation on personal wellbeing and especially for depression and anxiety is compelling. Meditation as a concept is moving from the fringes into the boardroom, the classroom and the counselling room.

On the 11th November we had a workshop run by William Bloom, a leader in the field and author of books such as The Endorphin Effect, Meditation in a Changing World, and The Power of Modern Spirituality. Its aim was to support people from the helping professions in using meditation as a therapeutic strategy.

What struck me first was William’s passion for demystification. He wants people to understand how accessible it is: we can meditate anywhere. We don’t have to sit cross-legged. We can do it in the garden with a glass of wine (“but probably not three”), we can do it while we are dancing, or running or after yoga. We can make it fit us. We don’t have to bend ourselves out of shape.

The day was a mix of guided meditations, group exercises and theoretical underpinning. William introduced one beautiful exercise he called the ‘inner smile’ which harnessed our ability to feel compassion for a hurt child or a wounded bird and then turn the same ‘kind mind’ on our own failings and vulnerabilities. At another point he used participants to create a constellation of the competing aspects of one person’s personality, all calling out for attention, repeating core beliefs and yelling. As an embodiment it was a powerful way of understanding the noise in our own heads that can make meditation, and sustaining that place of ‘quiet mind’, so challenging. For me this was a key moment. As a psychotherapist I have many clients who find it almost impossible to be still and to be in contact with themselves. For them it can be an uncomfortable, even terrifying, experience. And yet we know that for people with a fragile self-process, meditation can help develop an ability to self-regulate and put the world into context. I found myself craving more at this point in terms of understanding how to create that safe bridge and safe container for my clients.

William Bloom brings a breadth and depth of understanding and a passionate commitment to his subject. This was not a workshop necessarily geared towards those who are already integrating a meditative practice. As an introduction to the field it was sustaining and enlivening.

The “Parents and Teens” talk, by parenting expert and agony aunt Suzie Hayman, followed by Q and A, at St John’s School, Marlborough on 22nd October 2016, was a must for any parent with children about to embark on their teenage years, or indeed any parent already in the midst of this often challenging and turbulent time. I only wish I had heard these words of wisdom long ago, both from Suzie herself, and also the teenagers contributing to the discussion.

Suzie has many years of experience counselling families and couples, and is also an agony aunt, broadcaster and author of 30 books on families, but most noticeably her own experience as a stepmother. She is a warm and wise soul, who brought clarity and calm to this topic without denying the challenges involved.

Suzie starts from the core view that the teenager’s main task is to separate from his/her birth family, while our job as parents is to manage these shifting boundaries while passing control over to the teen. And no, she does not say this is easy. Her approach is practical and pragmatic, and she makes you feel you too could manage this. She gives helpful hints for how to relate to your child in a way that enhances communication, and on how you might approach such thorny subjects as alcohol use and pornography. She entreats us to remember that a problem might actually be our own, rather than theirs, such as our own expectations or dreams being acted out. She never pretends to have all the answers but offers a framework to work from.

The ensuing discussion brought enlightening tips from the teens present, whose overriding message was “please, just listen to us”, since we might not have any idea what our child is experiencing, as well as “be available”, in other words sometimes we need to wait until they are ready to talk rather than rushing in with our own agenda. The wide-ranging questions and discussions from the audience could easily have gone on past the allotted time.

This well-organised seminar in congenial surroundings will, I hope, be the first of many such events. Highly recommended!

Wendy Bramham Therapy has contributed their expertise about mental health on BBC Wiltshire in 2013 and again recently.

In March 2016 we were asked to contribute to a discussion about whether time is a healer. One of our team, Briony Martin, stepped into the breach to discuss this topic with radio presenter Graham Seaman. Listen here

In 2013, when BBC Wilts presenter, Mark O’Donnell, suffered a panic attack in the streets of Swindon – and found that people gave him a wide berth! – he decided to try to break down the myths, fears and stigma surrounding mental health, by talking about it on the radio!

Our modern western lifestyle, and particularly following industrialisation over 100 years ago, means that we have become much less physically active. Our great grandparents had to be active just to carry out their everyday life.

Exercise shouldn’t be a chore! Rather than jogging or going to the gym, consider things like gardening, dancing, or walking in nature. It is important to find an activity you ENJOY, and to do something quickly enough so that you raise your heart rate (aerobic exercise), as it is then that the “happy” chemicals called endorphins are released into our body and make us feel good.

The Royal college of Psychiatrists state on their website that “if you keep active, you are:

less likely to be depressed, anxious or tense

more likely to feel good about yourself

more likely to concentrate and focus better

more likely to sleep better

more likely to cope with cravings and withdrawal symptoms if you try to give up a habit such as smoking or alcohol

more likely to be able to keep mobile and independent as you get older

possibly less likely to have problems with memory and dementia.”

Tips on getting started:

It is vital to pick an activity that you ENJOY

Any exercise is better than none.

Don’t start suddenly – build more physical activity into your life gradually, in small steps.

How well does exercise work for depression?

For mild depression, physical activity can act as a natural anti-depressant, and be as (or more) effective for some people than medication. In some areas in the UK, GPs (family doctors) can prescribe exercise.

Doing 30 minutes or more of exercise a day for three to five days a week can significantly improve depression symptoms. But smaller amounts of activity — as little as 10 to 15 minutes at a time — can make a difference. (ref: Royal college psychiatrists). Moderate exercise is best, such as the equivalent of walking fast whilst you can still talk to someone.

The mental health benefits of exercise may last only if you stick with it over the long term — another good reason to focus on finding activities you enjoy.

Why does exercise work?

It helps to release feel-good brain chemicals (neurotransmitters and endorphins) into the brain, which can ease depression. Brain cells use these chemicals to communicate with each other, so they affect your mood and thinking.

Exercise can stimulate other chemicals in the brain called “brain derived neurotrophic factors” (BDNF). These help new brain cells to grow and develop. Moderate exercise seems to work better than vigorous exercise. BDNF seems to reduce harmful changes in the brain caused by extreme stress.

Harder exercise (perhaps needed to fight or flight from danger) can help to dispel the physical effects of a trauma, loss, shock or crises as it helps reduce adrenalin and produces endorphins. Animals in the wild naturally do this by fleeing from or fighting danger.

Exercise can also reduce risks of high blood pressure, diabetes, arthritis and cancer.

Exercise can also help you:

Gain confidence. Meeting exercise goals or challenges, even small ones, can boost your self-confidence and help you to feel more in control.

Take your mind off worries. Exercise is a distraction that can get you away from the cycle of negative thoughts that feed anxiety and depression.

Get more social interaction. Exercise may give you the chance to meet or socialize with others.

Cope in a healthy way. Doing something positive to manage anxiety or depression is a healthy coping strategy. Trying to feel better by drinking alcohol, dwelling on how badly you feel, or hoping anxiety or depression will go away on its own can lead to worsening symptoms.

How do I get started — and stay motivated?

Starting and sticking with an exercise routine can be a challenge. Here are some steps that can help. Check with your doctor before starting a new exercise program to make sure it’s safe for you.

Identify what you enjoy doing. Figure out what type of physical activities you’re most likely to do, and think about when and how you’d be most likely to follow through. Do what you enjoy to help you stick with it.

Get your mental health provider’s support. Talk to your doctor or other mental health provider for guidance and support.

Set reasonable goals. Your mission doesn’t have to be walking for an hour five days a week. Think realistically about what you may be able to do. Tailor your plan to your own needs and abilities rather than trying to meet unrealistic guidelines that you’re unlikely to meet.

Don’t think of exercise as a chore. If exercise is just another “should” in your life that you don’t think you’re living up to, you’ll associate it with failure. Rather, look at your exercise schedule the same way you look at your therapy sessions or medication — as one of the tools to help you get better.

Address your barriers. Figure out what’s stopping you from exercising. If you feel self-conscious, for instance, you may want to exercise at home. If you stick to goals better with a partner, find a friend to work out with. If you don’t have money to spend on exercise gear, do something that’s virtually cost-free, such as walking. If you think about what’s stopping you from exercising, you can probably find an alternative solution.

Prepare for setbacks and obstacles. Give yourself credit for every step in the right direction, no matter how small. If you skip exercise one day, that doesn’t mean you can’t maintain an exercise routine and may as well quit. Just try again the next day.

On a clear, sunny autumnal Saturday last week, I was treated to a full day’s seminar on depression… the conflict of light and dark didn’t pass by un-noticed and in fact resulted in a feeling of optimism and lightness – a surprise considering the darkness and negativity of the topic. Gill Bannister delivered her seminar with feeling and containment – two very important aspects of a therapist’s role when working with clients with depression.

Gill’s 30 years experience as a psychoanalytic psychotherapist working with depression in clients was delivered in a style in keeping with her classic training, enabling us to have time and space to think, to sit with ourselves and our difficult thoughts and feelings, allowing a process to occur. Gill believes that depression is a result of a client experiencing loss. The depressed client suffers from a lack of self esteem, often projecting a super-ego which is rejecting, despising and attacking.

The experiential element of the seminar was invaluable, thinking and sharing thoughts, Gill challenged us to confront our own assumptions, experiences and prejudices around depression. A word which is now loaded with a vast array of interpretation and stigma. We were guided through the day with exercises and discussion which enabled us to experience the core essence of working with depression in the therapeutic room – trying to get in touch with our client’s inner world. By experiencing a 30 minute solo role play, I felt more connected and understanding of my client’s depression than I had done before and will be processing and using these insights future sessions with this particular client.

This seminar was assessed by attendees as 4.69 out of 5 for the overall quality of the event. The speaker was rated 4.75. Thank you to all who attended this and previous seminars, we appreciate your participation and your feedback.

“When someone is in therapy it can seem like self-absorption to those around them, but this is a necessary and temporary state. Regular, well-boundaried therapy ideally leads to people developing clearer awareness of themselves and how they relate to others. The dynamics may change within their relationships. They may take a more equal footing in relationships that have previously diminished their self-value, or realise that there are areas in the relationship that they could give more to. The goal of therapy either way, is increased contentment for all parties, both the client and those around them – which is an act of love as well as self-love.”

Cassandra Human, psychotherapist

“On a visit to Laos recently I saw how the many statues of Buddha depict ‘The Enlightened One’ looking down. Locals told me this symbolises His focus on looking within himself to find enlightenment. Rather than this being a selfish act He believed that, in order to bring about change, we need to search within ourselves for answers. How tempting and easy it is for us to want others to change in order for us to be happy, or to look to others to carry the blame or take responsibility; and how brave it can feel to focus instead on taking responsibility for ourselves and our own decisions, life and happiness. Therapy provides a safe forum for our inner search and our exploration of the changes this can bring.”